| NPI | 1770209595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5016956) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5016956) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5016956) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5016956) | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2024-07-24 |